* Correspondin

1876-1399/$ - se

doi:10.1016/j.ec

Clinical Simulation in Nursing (2012) 8, e335-e340

www.elsevier.com/locate/ecsn

Featured Article

From Static Lab to Simulation Lab: StudentsReflect on Their Learning

Sherrilyn Coffman, PhD, RN*School of Nursing, Nevada State College, Henderson, NV 89015, USA

KEYWORDSsimulation;experiential learning;nursing skills;phenomenologicalresearch

g author: Sherrilyn.Coffm

e front matter � 2012 Int

ns.2011.01.003

Background: Nursing faculty are challenged to incorporate use of low, moderate, and high-fidelitysimulators into the curriculum and to evaluate student learning. This study compares students’ percep-

Abstract

tions of learning across levels of simulation.Method: Colaizzi’s descriptive phenomenological method was used, with data collection at two times:(a) after a static lab using low-fidelity task trainers and (b) after a simulation lab incorporating high-fidelity manikins. Students were asked to describe their learning after each lab. Written comments wereanalyzed, and themes from each time were compared. Findings were taken back to participants forvalidation.Results: Students’ comments indicated a progression of learning from the what, when, how, and whyof psychomotor skills in the static lab to more complex concepts such as assessing, prioritizing, relat-ing information, and formulating therapeutic interventions in the high-fidelity simulation lab.Conclusions: Study results confirm that students are able to recognize progression in learning, fromperforming psychomotor skills to making clinical judgments, as they engage in strategically plannedlab experiences.

Cite this article:Coffman, S. (2012, October). From static lab to simulation lab: Students reflect on their learning. Clin-ical Simulation in Nursing, 8(8), e335-e340. doi:10.1016/j.ecns.2011.01.003

� 2012 International Nursing Association for Clinical Simulation and Learning. Published by ElsevierInc.

Skills labs are not new to nursing education. To prepare representing specific body parts (Nagle, McHale,

students to deal with numerous advances in patient caretechnology after World War II, nursing programs developedlaboratory courses for practice of psychomotor skills(Hovancsek, 2007). Students practiced skills using tasktrainers such as injection pads and artificial arms. Theselab activities more closely resembled reality as case studiesand role playing were incorporated into the lab. Today’slow-fidelity simulation lab uses these same techniques,along with sophisticated task trainers that are static models

an@nsc.nevada.edu (S. Coffman).

ernational Nursing Association for Clinica

Alexander, & French, 2009). In the static lab, students prac-tice technical procedures such as catheterization and veni-puncture. Learners are able to improve performancethrough repeated practice and to link skills to clinical prac-tice by situating skills within case studies.

In addition to low-fidelity simulators, the contemporaryskills lab incorporates advanced simulation technologies.Moderate-fidelity simulators are full-body manikins thatallow students to listen for heart sounds and breath soundsand to feel for some pulses. High-fidelity simulators arecomputerized to provide real-time physiological parameters

l Simulation and Learning. Published by Elsevier Inc.

From Static Lab to Simulation Lab e336

such as chest movements, changing vital signs, or dilatingpupils. These patient simulators can be instructor-driven ormodel-driven, producing scenarios that mimic real clinicalsituations (Nehring & Lashley, 2010). Moderate and high-fidelity simulation scenarios provide students with opportu-

Key Points� Students’ commentsindicated a progres-sion of learning fromstatic lab to simula-tion lab.

� Learning themes fromthe simulation lab in-cluded prioritizing,assessment, relatinginformation, and ther-apeutic interventions.

� Educators need to de-sign static-lab learningthat students can buildon, preparing them forsimulations requiringmore complex clinicaljudgments.

nities to improve clinicaldecision making, practiceskills, and make connec-tions in new learning.

Outcomes ofSimulation

Jeffries and Rogers (2007)reviewed the literature onsimulation and noted thatoutcomes included in-creased knowledge, skillsperformance, learner satis-faction, critical thinking,and self-confidence. In theirnational multisite study,these authors found that stu-dents who worked withhigh-fidelity patient simula-tors were more satisfied

with instructional methods and reported greater self-confidence in their ability to provide postoperative carethan students experiencing conventional training methods.They attributed this finding to more active learning andmore diverse ways of learning than in other educationalexperiences.

Multiple studies have focused on exploration of stu-dents’ perceptions and evaluations of simulation as a learn-ing experience. A systematic review by Cant and Cooper(2009) included 12 quantitative studies. All studies foundthat students perceived simulation as a valid teaching andlearning strategy. Six of the studies showed that studentsgained in knowledge, critical thinking, satisfaction, or con-fidence, compared with a control group.

Research shows that students are very satisfied withsimulation learning involving clinical scenarios (Bearnson& Wiker, 2005; Curtin & Dupuis, 2008; Dillard et al.,2009; Starkweather & Kardong-Edgren, 2008). Smith andRoehrs (2009) found that student satisfaction and self-confidence were significantly correlated with clear objec-tives and appropriately challenging problems to solve.Another study found no difference in confidence level be-tween students who participated in a simulation experienceand students who received a traditional lecture approach,although knowledge scores increased significantly in thesimulation group (Brannan, White, & Bezanson, 2008).Likewise, Elfrink, Kirkpatrick, Nininger, and Schubert(2010) found that knowledge of simulation-related contentsignificantly improved for students after lab participation.

pp e335-

Researchers have also noted an improvement in criticalthinking (Ravert, 2008; Sullivan-Mann, Perron, & Fellner,2009).

Several qualitative studies focused on students’ percep-tions of simulation. Themes from a study by Lasater(2007) included the paradoxical nature of simulationdthatit increased anxiety yet also increased learning and aware-ness. In a study by Reilly and Spratt (2007), students indi-cated they believed that the simulation experienceincreased their confidence and better prepared them forthe clinical setting. Research by Kiat, Mei, Nagammal,and Jonnie (2007) found that simulation-based trainingwas perceived to be beneficial to students because it al-lowed them to think on their feet, discover weaknessesthey needed to remedy, and make mistakes without causingharm to real patients.

Only one study was found that compared learning inthe traditional low-fidelity static lab with learning in thehuman patient simulator lab. Bremner, Aduddell, andAmason (2008) studied an experimental group of stu-dents who were instructed to work with the simulator‘‘as they would a real patient’’ (Methodology section,{ 1). A control group of students participated in theirusual skills lab practice. At 1 week after their first hos-pital clinical experience, students in the simulation groupexhibited lower levels of anxiety than did students in thestatic lab.

My study also compared the static lab and simulationlab. In formulating this study, I questioned how students inmy school of nursing perceived different lab experiences,including the traditional static lab and the high-fidelitysimulation lab. The questions arose, What do students thinkabout the two types of learning situations? How do studentsdescribe the differences in the two types of labs? As theyreflect on the different lab experiences, do they recognizethe differences in learning opportunities?

Method

The study originated from my experiences with students ina maternalechild skills lab in a baccalaureate nursingprogram. I sought a deeper understanding of students’ per-ceptions about their learning. Colaizzi’s (1978) descriptivephenomenology method was used. Descriptive phenome-nology aims to capture the meaning of an experiencethrough identification of essential themes (Polit & Beck,2008). The phenomenological framework is founded onthe principle that individuals assign meanings to their worldthrough conscious reflection on situations. Because phe-nomenological research is conducted in naturalistic set-tings, this method allows the researcher to capture,interpret, and understand lived experiences.

Descriptive phenomenological studies often involve foursteps described by Polit and Beck (2008). All steps werefollowed in this study.

e340 � Clinical Simulation in Nursing � Volume 8 � Issue 8

Table 1 Overview of Simulation Scenario: Child With Rup-tured Appendix on Postoperative Day 1

Estimated scenario time: 20 minutesEstimated debriefing time: 30 minutesTarget group: Second-semester junior year nursing students inmaternalechild skills lab

Setting: Simulated hospital pediatric unitLearning objectives:1. Apply knowledge of physical assessment, pain assessment,

fluid balance, pharmacology, IV therapy, oxygenation,mobility, growth and development, and therapeuticcommunication.

2. Demonstrate application of nursing skills related to IVtherapy, nasogastric (NG) decompression, medication ad-ministration, oxygen administration, pain assessment inschool-age child.

3. Use informed clinical judgment in clinical problem solvingof abnormal intake and output, NG tube malfunction,hypoxia, pain.

4. Demonstrate caring interactions and therapeutic commu-nication with children and parents.

Description of scenario: The scenario focuses on nursing careof a hospitalized 5-year-old child with ruptured appendix onPostoperative Day 1. The child is NPO with IV fluids through

From Static Lab to Simulation Lab e337

Step 1: Bracketing, or setting aside personal beliefs andopinions about the phenomenon under study. In thisstudy, before collecting data, I consciously identifiedmy beliefs about how students perceived learning inthe lab.Step 2: Intuiting, or remaining open to the students’ de-scriptions. The data collection process was designed topromote open reflection by students.Step 3: Analyzing, or extracting significant statements,categorizing into themes, and making sense of the mean-ing of descriptions. I am experienced in qualitative dataanalysis and followed accepted analysis strategies.Step 4: Describing, or integrating results into an exhaus-tive description of the phenomenon. After writing studyresults, I took findings back to participants forvalidation.

The aim of the study was to describe how studentsperceived their learning in two lab situations focusing onnasogastric (NG) tube care. The specific research questionwas, How do nursing students, through written reflection,describe their learning in a static lab as compared witha simulation lab? Participants included 31 students in thesecond semester of their junior year in a traditionalbaccalaureate program. All students were enrolled in thematernalechild nursing skills lab.

Data collection took place at two times: (a) at theconclusion of a static lab focusing on NG and other enteraltube care and (b) after a simulation lab focusing on a childwith an NG tube on Postoperative Day 1 after appendec-tomy. These labs occurred in Weeks 13 and 14 of a 15-weeksemester. Data consisted of written responses to thefollowing question: ‘‘What did you learn about nasogastrictube care in today’s skills lab?’’

a peripherally inserted central catheter line and NG tubedecompression. Pain level is 8 on the FACES scale, and thechild requires ambulation. Clinical decision making centerson the following issues: (a) assessment and treatment ofpain, (b) NG tube malfunction, (c) abdominal assessment,(d) analysis of intake and output, (e) monitoring ofoxygenation, (f) administration of IV medications, (g)monitoring IV fluids and peripherally inserted centralcatheter line site, and (h) decisions about ambulation.

Roles of students: Primary nurse (new graduate)Secondary nurse (preceptor)Charge nursePediatric surgeonPatient’s motherObservers

Implementation of the simulation:Students in the simulation room included those in roles ofprimary, secondary, and charge nurses, as well as onestudent who played the patient’s parent. The two to threeobservers and the student who played the role of surgeonobserved the scenario by video in a separate conferenceroom. The instructors sat with a technician behind a one-way mirror. One instructor played the voice of the manikin.

Data Collection 1 (Static Lab)

The objective of the low-fidelity static lab was to provideexposure to various types of enteral tubes, with practice andperformance testing on NG tube insertion, placementchecks, irrigation, and removal. Student preparation beforelab consisted of reading assigned sections in textbooks andviewing videos of skills procedures. During the lab,students practiced NG care, using task trainers to performskills. Brief clinical scenarios were provided to structurepractice and help students relate skills to clinical situations.Practice was immediately followed by a graded demon-stration, using a procedure check list, in front of theinstructor.

At the end of the lab session, students were invited toparticipate in a study regarding the skills lab activities. Aninformation and data sheet was distributed, which includedthese instructions:

Your participation is requested in a class activity thatanalyzes student learning in skills lab.. Please

pp e335-

reflect on the following question: What did you learnabout nasogastric tube care in today’s skills lab?.Make your response as thoughtful and complete asyou can.

The information and data sheet included space forstudents to write their responses.

e340 � Clinical Simulation in Nursing � Volume 8 � Issue 8

From Static Lab to Simulation Lab e338

Data Collection 2 (Simulation Lab)

Using a high-fidelity, age-appropriate manikin, the simula-tion lab focused on care of a child with a ruptured appendixon the first postoperative day (see Table 1). This lab tookplace 1 week after the static lab. Students were given basicinformation, including the diagnosis and names of medica-tions, to use in preparation. On the day of the simulation,students were divided into four groups of seven to eight stu-dents. The simulation lab scenario began with morning re-port to the primary nurse. Problem solving focused onmalfunction of the NG tube. Students used the skillslearned in the static lab, such as checking the NG tube’s po-sition, irrigating the tube, and reinserting it. Additionally,students assessed the patient and related signs and symp-toms to NG tube malfunction, made decisions about medi-cations, prioritized actions, and consulted team members.Debriefing followed the scenario.

Data collection took place after debriefing. Studentswere given the same information and data sheet used afterthe static lab. The question remained the same: ‘‘What didyou learn about nasogastric tube care in today’s skills lab?’’Students completed their written responses in 10 to 15minutes.

Protection of Participants

The student cohort consisted of 31 students. Participants atTime 1 included 23 students, and at Time 2, 31 students. Noidentifying information was written on the students’ answersheets. Participation was voluntary, all responses wereanonymous, and students were reassured in writing thattheir course grade would not be affected. A student teachercollected the data sheets. Return of the anonymous datasheet was considered to be proof of consent. The studywas approved by the college’s institutional review board.

Data Analysis

The researcher remained mindful of personal beliefs andassumptions, bracketing these during thematic analysis.Students’ written responses were reviewed, and themes-were derived for each time, following Colaizzi’s (1978)steps: (a) read and review students’ responses and extractsignificant statements, (b) formulate meanings of state-ments and organize them into themes, (c) integrate resultsinto an exhaustive description of the phenomenon, and(d) return to participants to share and validate the descrip-tion. Themes from each data collection period were derivedfollowing Steps (a) and (b) above. Findings from the twodata collection periods were compared as part of continuingdata analysis, resulting in an exhaustive description thatcontrasted learning in the two different labs. This descrip-tion was taken back to nine students for consideration ofaccuracy. Students validated that the description accuratelycaptured their perceptions of learning in the two labs.

pp e335-

Integrity of Research

Lincoln and Guba (1985) proposed four criteria for assess-ing the integrity of qualitative research. Credibility, or con-fidence in the truth of the data, was established as theresearcher bracketed her own opinions, gave participantstime to reflect on their experiences, and returned to partic-ipants for validation of study findings. Dependability wasestablished by describing and following the steps of the re-search process, from research question through data analy-sis, thus providing an audit trail. Confirmability refers toobjectivity, achieved by validation from participants thatthe study findings described their own ideas, and notmine. Transferability refers to the fittingness or applicabil-ity of findings to other groups and settings, as judged by thereader. To enable readers to judge whether findings appliedto other groups, I supplied quotes from participants to sup-port study themes and descriptions.

Results

Students described their learning after the static lab and 1week later, after the simulation lab.

Students’ Learning After Static Lab

Students’ comments after the static lab focused on psycho-motor skills, including the steps of NG care that were in-cluded in the performance check list. Themes included

� Types of NG tubes (sump, levine)� Sizes and configuration of different tubes� How to insert tube, check placement, irrigate, and re-move tube

� When to remove the tube� Why NG tubes are useddfor medications, feedings,decompression

� Purpose of irrigating tube

Several of these themes were included in one student’scomments: ‘‘I learned about NG tube [s] such as checkingplacement, insertion of NG tubes, and the different types ofNG tubes and when to use them.’’ Students also commentedon the importance of viewing demonstrations and practic-ing new skills, as compared with reading: ‘‘Today I learnedthe proper technique of placing, irrigating, & removing NGtubes. No matter how much I read how to do my skills, theynever stick. A visual demonstration is so much nicer.’’

Student Learning After Simulation Lab

Students’ responses about learning in the simulation lab sit-uated psychomotor skills within the larger context of nurs-ing care. Much broader learning was described, ascompared to learning in the static lab. Themes included

e340 � Clinical Simulation in Nursing � Volume 8 � Issue 8

From Static Lab to Simulation Lab e339

� PrioritizingB First priority is to check placementB Better to replace tube before giving nausea meds

� AssessmentB Check tube placement along with vital signsB Listen to the patient’s complaints

� Relating informationB Understanding the relationship between signs andsymptoms (distention, nausea) and NG function

B Consequences of incorrect NG placement� Therapeutic interventions

B When to check with the physicianB Need to replace the tube in the proper position

Students’ comments reflected the themes of assessmentand prioritization: ‘‘Today I learned that the first priorityis to always check placement.’’ Another student clarified,‘‘[I learned] to check NG tube placement when doing firstset of vitals early in the beginning of the shift.’’ An advan-tage of high-fidelity simulation is that the manikin (patient)can be given a voice, which formed the basis for this com-ment: ‘‘Listen to the patient; listen for cues that they maybe giving.’’

In the simulation lab, students were challenged to relatesigns and symptoms to potential complications. Thislearning was reflected in the comment, ‘‘When patientcomplains of severe abdominal distention, NG tube may bedisplaced; always check NG tube.’’ Furthermore, relatinginformation provided the rationale for therapeutic interven-tions. This was reflected in the statement, ‘‘Placing the NGtube back in place will stop the nausea/vomiting.’’

Students recognized that the simulation lab exposedthem to new situations that required them to think critically.One student stated this clearly: ‘‘In skills lab, we justlearned how to assess placement after insertion of tube, butthe sim lab helped more with critical thinking.’’

The uniqueness of the simulation lab experience wasdescribed by another student: ‘‘It might seem commonsense but sometimes unless it’s presented to you, it justdoesn’t occur to you.’’ Additionally, students were able todraw connections between the high-fidelity simulation laband future clinical experiences. As one student said: ‘‘Itwas a great experience for the future.’’

Comparison of Themes From the Static Lab and theSimulation Lab

As described by students, static lab learning focused on thewhat, when, how, and why of psychomotor skills. In com-parison, learning themes from the simulation lab includedassessing, prioritizing, relating information, and formulat-ing therapeutic interventions. These differences indicatethat students recognized the expansion from learning psy-chomotor skills to thinking critically and making clinicaljudgments.

pp e335-

Additionally, students described a progression in learn-ing content, from determining how to check NG tubeposition in the static lab to recognizing signs and symptomsof tube obstruction in a ‘‘patient’’ in the simulation lab.Students recognized the difference in the focus of each typeof lab. They described the focus of static lab as the processof learning psychomotor skills–steps in NG tube insertion,how to check position, and so forth. They recognized thefocus of the simulation lab as making clinical judg-mentsdtiming of assessment of NG position, prioritizationof checking tube before giving nausea meds, and othercomplex activities.

During the validation phase, students confirmed that thestudy findings accurately portrayed their perceptions oflearning in the lab. When asked if anything had beenomitted from the description of findings, one studentsuggested I relay this comment:

You could add that now, several months later, in theER I was put in a situation to insert an NG tube.When I got nervous because the staff nurse was busyadministering IV antibiotics, I closed my eyes fora second and reflected on what we were taught thatday in lab and successfully and safely inserted theNG tube without complications.

For this student, learning was both significant and longlasting.

Discussion

Students’ perceptions are consistent with the nursing edu-cation literature regarding the purposes and benefits of dif-ferent levels of simulation. While generalizability to othereducational programs cannot be done because of the ex-ploratory design and small sample, our own school of nurs-ing has gained valuable information about students’learning perceptions in our program. Implications for ourown setting are described here.

Students acknowledged that the static lab had a purpose:It (a) provided the setting and equipment to learn psycho-motor skills, (b) allowed for repeated practice, (c) provideda forum to discuss the rationale for skills, and (d) provideda safe learning environment. Students described the high-fidelity simulation lab as a learning environment wherethey could ‘‘put it all together,’’ incorporating the psycho-motor skills in a complex clinical situation requiringprioritizing and critical thinking. Driven by student de-cisions, the simulation lab encouraged student reflection,analysis, and critical thinking.

With the rapid adoption of high-fidelity scenarios in thesimulation lab, faculty members need to consider the static-lab learning experiences that prepare students for thesescenarios. Educators need to carefully design static-lablearning that students can build on, preparing them to moveon to situations requiring more complex clinical judgments.

e340 � Clinical Simulation in Nursing � Volume 8 � Issue 8

From Static Lab to Simulation Lab e340

Likewise, learning experiences in the simulation lab shouldprovide a valuable intermediate step to caring for patientsin the clinical setting. Evidence from other studies validatesthat simulation learning complements, but does not replace,real patient contact (Issenberg et al., 2005).

Faculty are challenged to design lab courses that buildconsecutively in terms of course content and process. Whencourse objectives are logically developed in a progressivefashion, students receive adequate preparation in the staticlab to learn successfully in the simulation lab. The studentsare able to build on previously learned skills. Likewise, forbeginning students, moderate and high-fidelity scenarioscan be developed that progress from simple situations tomore complex ones, based on students’ progression in thenursing program. The importance of matching students’level of knowledge with the complexity of simulation hasbeen emphasized by other researchers (Jeffries & Rogers,2007; Reilly & Spratt, 2007). Results of this study supportthe approach we are using in our simulation labs and areconsistent with recommendations from the literature. Aswe develop more simulation scenarios, faculty will havemore resources to use in their strategic planning betweenstatic lab and simulation lab.

Conclusion

Simple questionnaires like the one used in this study canhelp faculty validate that students’ perceptions of learningare in line with faculty expectations. The results of thisqualitative study provide evidence that students in our pro-gram are successfully building on learning experiencesfrom static lab to simulation lab as they progress throughthe curriculum. Students’ comments about their learningin simulation lab also validate that lab scenarios challengethem to make clinical judgments and prepare them forlearning in clinical settings.

References

Bearnson, C., & Wilker, K. (2005). Human patient simulators: A new face

in baccalaureate nursing education at Brigham Young University.

Journal of Nursing Education, 44, 421-425.

Brannan, J., White, A., & Bezanson, J. (2008). Simulator effect on cognitive

skills and confidence levels. Journal of Nursing Education, 47, 495-500.

Bremner, M., Aduddell, K., & Amason, J. (2008). Evidence-based practice

related to the human patient simulator and first year baccalaureate nurs-

ing students’ anxiety. Online Journal of Nursing Informatics, 12(1).

Retrieved January 26, 2011, from www.cinahl.com/cgi-bin/refsvc?

jid=1536&accno=2009863807.

Cant, R., & Cooper, S. (2009). Simulation-based learning in nurse educa-

tion: A systematic review. Journal of Advanced Nursing, 66(1), 3-15.

pp e335-

Colaizzi, P. F. (1978). Psychological research as the phenomenologist

views it. In R. Valle, & M. King (Eds.), Existential phenomenological

alternative for psychology (pp. 48-71). New York: Oxford University

Press.

Curtin, M., & Dupuis, M. (2008). Development of human patient simula-

tion programs: Achieving big results with a small budget. Journal of

Nursing Education, 47, 522-523.

Dillard, N., Sideras, S., Ryan, M., Carlton, H., Lasater, K., & Siktberg, L.

(2009). A collaborative project to apply and evaluate the clinical judg-

ment model through simulation. Nursing Education Research, 30(2),

99-104.

Elfrink, V., Kirkpatrick, B., Nininger, J., & Schubert, C. (2010). Using

learning outcomes to inform teaching practices in human patient simu-

lation. Nursing Education Perspectives, 31(2), 97-100. doi:

10.1043/1536-5026-31.2.97.

Hovancsek, M. (2007). Using simulations in nursing education. In

P. Jeffries (Ed.), Simulation in nursing education: From conceptualiza-

tion to evaluation (pp. 1-7). New York: National League for Nursing.

doi:10.1043/1536-5026(2005)026<0096:AFWFDI>2.0.CO;2.

Issenberg, S. B., McGaghie, W., Petrusa, E., Gordon, D., & Scalese, R.

(2005). Features and uses of hi-fidelity medical simulations that lead

to effective learning: A BEME systematic review. Medical Teacher,

27(1), 10-28. doi:10.1080/01421590500046924.

Jeffries, P., & Rogers, K. (2007). Evaluating simulations. In P. Jeffries

(Ed.), Simulation in nursing education: From conceptualization to eval-

uation (pp. 87-103). New York: National League for Nursing.

Kiat, T. K., Mei, T. Y., Nagammal, S., & Jonnie, A. D. (2007). A review of

learners’ experience with simulation based training in nursing. Singa-

pore Nursing Journal, 34(4), 37-43.

Lasater, K. (2007). High-fidelity simulation and the development of clini-

cal judgment: Students’ experiences. Journal of Nursing Education,

46(6), 269-276.

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills,

CA: Sage. doi:10.1002/ev.1451.

Nagle, B., McHale, J., Alexander, G., & French, B. (2009). Incorporating

scenario-based simulation into a hospital nursing education program.

Journal of Continuing Education in Nursing, 40(1), 18-25.

Nehring, W., & Lashley, F. (2010). High-fidelity patient simulation in nurs-

ing education. Sudbury, MA: Jones & Bartlett. doi:

10.1016/j.profnurs.2007.06.027.

Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and as-

sessing evidence for nursing practice (8th ed.). Philadelphia: J.B.

Lippincott.

Ravert, P. (2008). Patient simulator sessions and critical thinking. Journal

of Nursing Education, 47, 557-562.

Reilly, A., & Spratt, C. (2007). The perceptions of undergraduate student

nurses of high-fidelity simulation-based learning: A case report from the

University of Tasmania. Nurse Education Today, 27, 542-550. doi:

10.1016/j.nedt.2006.08.015.

Smith, S., & Roehrs, C. (2009). Factors correlated with nursing student sat-

isfaction and self-confidence. Nursing Education Perspectives, 30(2),

74-78. doi:10.1043/1536-5026-030.002.0074.

Starkweather, A., & Kardong-Edgren, S. (2008). Diffusion of innovation:

Embedding simulation into nursing curricula. International Journal of

Nursing Education Scholarship, 5(1), 1-11. doi:10.2202/1548-

923X.1567.

Sullivan-Mann, J., Perron, C., & Fellner, A. (2009). The effects of simula-

tion on nursing students’ critical thinking scores: A quantitative study.

Newborn & Infant Nursing Reviews, 9(2), 111-116. doi:

10.1053/j.nainr.2009.03.006.

e340 � Clinical Simulation in Nursing � Volume 8 � Issue 8